Mary Butler (Waterford, Fianna Fail)
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I thank the Leas-Cheann Comhairle and his office for facilitating this Topical Issue, which represents cross-party and cross-county support. Fourteen of the 19 Deputies in the south-east are supporting this petition and I thank my colleagues for doing so.

As the Minister of State is aware, there is currently no provision for cardiology cover in Waterford and the south east after 5 p.m. every weekday, and no availability at all at the weekend. It is simply not acceptable in 2017 that time restrictions play such a role in the day-to-day lives and deaths of our people. Last Saturday in excess of 7,000 people took to the streets of Waterford to vent their anger, frustration and hurt.

I have a question to ask and, as I was hoping to ask it of the Minister, Deputy Harris, I want to put on record that I am disappointed he is not present. Why are we in Waterford and the south east being treated as second-class citizens? It is ironic that while we were taking to the streets in Waterford last Saturday, an Air Corps helicopter had to come to Waterford to bring a patient to University Hospital Cork and an ambulance was ferrying another patient to Cork. Why is the south east the only region without 24-7 cardiology cover? Why are we excluded from life-saving care? Make no mistake about it: cardiac intervention saves lives every single day. There is a solution and it is clear what is needed, namely, additional resourcing in the form of a second cath lab with sufficient staff to resource it. That is the solution and that is what we want. This solution would have a two-fold effect. First, it would save lives and, second, it would help to reduce waiting lists in Waterford and the surrounding counties of Tipperary, Kilkenny and Wexford.

The budget allocation for this year is in excess of €14 billion. The cost of providing this second cath lab is a €2.6 million one-off capital investment and an additional €2 million per year to cover running costs. This has to happen sooner rather than later.

David Cullinane (Waterford, Sinn Fein)
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I want to ask what is going on. We have 14 of the 19 Oireachtas Members in the south east involved, 12 of whom put their names to this Topical Issue today, yet the Minister for Health, Deputy Harris, is not present. On previous occasions when we have put down similar matters, again, the Minister for Health was not here. He sneaked into Waterford a number of months ago, met with local hospital clinicians and consultants and met with one local Oireachtas Member, although he did not meet with the rest of us. Announcements are being made by other Ministers but we still have not heard from the Minister for Health himself. We are being treated with absolute contempt, and when I say "we", I mean the people of the south east. The Minister for Health needs to brief, talk to and communicate with, in the first instance, the people of the south east but also through us as elected representatives. I am outraged that when we have gone to the trouble of showing the level of regional unity and cross-party support that exists on this critical issue, the Minister is not here.

The reality, as the Minister of State, Deputy Halligan, and all other Oireachtas Members know, is that there is a real problem of patient care and patient safety, and a lack of equality, in the south east. If a person has a heart attack after 5 p.m. or 6 p.m. any day of the week in any part of the south east, be it Waterford, Carlow, Kilkenny, Tipperary or Wexford, that person will have to go to Cork or Dublin for emergency treatment. It is the only region in the State which does not have 24-7 emergency cardiac care. We are not getting any justification from the Minister as to why we are being denied this. The Higgins report again committed the south east, in particular University Hospital Waterford, to providing interventional cardiology to the people of the south east. In addition, we hear today that this so-called mobile cath lab is not for the south east alone and that it is going to be for a number of hospitals across the State. This also needs to be clarified by the Minister of State.

Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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I want to join with my colleagues in expressing my disappointment that the Minister is not present to face us and to discuss the supply of a 24-7 service in the south east. As has been said, it is the only region in the country that does not have a 24-7 service. Are we in the south east different to anyone else? Are we backward people who do not deserve the service everyone else in the country gets?

The situation surrounding cardiac care at University Hospital Waterford is at boiling point. Thousands of people took to the streets over the weekend in protest, despite the announcement by the Minister of State, Deputy Halligan, that a mobile unit has been made available to the people of the south east. I would like to know what a mobile unit is. Does this mean it will be there for one day in Waterford and somewhere else the day after? Will it be there for a week or a month before going somewhere else? If it is mobile, that means it is on wheels and it moves around. That is not an answer to the problem. We have no concrete details of this mobile cath lab and its capabilities. Will it be exclusive to University Hospital Waterford and will it be on-call 24-7? Will it be reserved for emergency cases or utilised in catering for those who have been on the waiting list for more than two years for vital cardiac procedures? How many people will the mobile unit be capable of catering for on an annual basis?

I remind the Minister that the catchment area for the current cardiac service in University Hospital Waterford consists of approximately 500,000 people in the counties of Carlow, Kilkenny, Wexford, south Tipperary, Waterford and further afield. The current cardiac service is simply not good enough for the people of the south east.

We have seven Deputies in the House today who have signed the motion to that effect. It is a petition to ask the Minister to look at this again. We have thousands on the streets to protest while there are over 700 on a waiting list for vital procedures, some of whom have been there for over two years. We have specialised doctors recognising the urgent need for a second cath lab and warning that some patients on the waiting list are deteriorating and need a procedure within the next seven days. We have advocacy groups saying that the mobile unit is a temporary solution to a permanent problem. The current situation in the south east is untenable as everyone has come to realise except the Minister for Health. We must take meaningful steps to implement 24-7 cardiac services at University Hospital Waterford immediately. I ask the Minister of State to bring that back to the senior Minister.

Pat Gallagher (Donegal, Fianna Fail)
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Is the Minister of State, Deputy Halligan, replying? Who is replying?

John Halligan (Waterford, Independent)
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I am not. The Minister is replying. I am making a contribution. I am not replying; I cannot.

Brendan Howlin (Wexford, Labour)
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Is there not collective responsibility in government?

John Halligan (Waterford, Independent)
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If I could reply, I would, but I am not allowed, apparently. I can only contribute. The Minister for Health can reply.

Brendan Howlin (Wexford, Labour)
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Any Minister can reply.

Pat Gallagher (Donegal, Fianna Fail)
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The Minister of State, Deputy Halligan.

Brendan Howlin (Wexford, Labour)
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On a point of order, any Minister can reply. The Minister of State says he cannot reply, but my understanding is that any Minister can do so.

John Halligan (Waterford, Independent)
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No. Out of courtesy, what I said was that the Minister for Health replies.

David Cullinane (Waterford, Sinn Fein)
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The Minister for Health is not here.

John Halligan (Waterford, Independent)
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That has nothing to do with me. I asked for speaking time on this issue. That is what I asked for.

Mattie McGrath (Tipperary, Independent)
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We are happy to give it to the Minister of State.

Brendan Howlin (Wexford, Labour)
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On behalf of the Department.

John Halligan (Waterford, Independent)
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I thank the Deputy. First, it is beyond question that cardiac waiting times in County Waterford and the south east are unacceptable. In fact, when I was in opposition, I brought this to the attention of the Dáil on a number of occasions and was the first Member to do so. I stand by my belief that the second lab is an absolute necessity and reiterate the point that it is not Waterford alone, but the south east that is involved. I stand by my belief that the Herity report was flawed, as many others have said, because of its terms of reference and because it did not include meetings, in particular with consultants in Wexford, Tipperary, Kilkenny or anywhere else in the south east. There is no question about that. Be that as it may, the Herity report is the Herity report and the Minister has said he will not change his mind on it.

The Minister acknowledged to me that he would come to Waterford to meet the consultants privately. I did not participate albeit I arranged for that meeting and for the Minister to come. The evidence of that meeting will be that I was there and did not participate in it. I had particularly asked the Minister to come. Nor did I participate in any announcements that the Minister had made for Waterford, some of which were quite good. I facilitated a meeting with all of the consultants. At that particular meeting, the consultants said they acknowledged they were gone past the Herity report and that we needed to go forward and it was their proposal, not mine, to use a mobile cath lab to deal with the 780 people on the waiting list and to carry out a further review. In my estimation, that is what has been agreed by the Minister. There will be a mobile cath lab in Waterford to deal with waiting lists and during that time a further review will take place with different terms of reference.

I can understand Sinn Féin being in opposition and not having been in government, but Fianna Fáil was in government for 20 years during which time we did not have a second cath lab. Fianna Fáil has the facility to put down a Private Members' motion to instruct the Government to deliver a second cath lab. The party has more power than the six people in the Independent Alliance. Fianna Fáil should come to the Dáil next week or the week after with a Private Members' motion, which would be supported by the House, including the Independent Alliance. The second cath lab would probably be delivered.

David Cullinane (Waterford, Sinn Fein)
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The Minister of State, Deputy Halligan, is passing the buck. He will have to deal with it. He has to stop playing politics with this issue.

John Halligan (Waterford, Independent)
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Deputy Cullinane played a lot of politics with it. He is a nasty piece. He played a lot of politics.

Mary Butler (Waterford, Fianna Fail)
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Stop passing the buck.

Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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Why does the Minister of State, Deputy Halligan, think we are here today?

Pat Gallagher (Donegal, Fianna Fail)
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I call Deputy Mattie McGrath to speak without interruption.

Mattie McGrath (Tipperary, Independent)
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I thank Deputy Mary Butler for tabling this matter, contacting all of us and organising it. I was glad to sign it. We do not know where we are. We need 24-7 cardiac and emergency care. The Minister of State, Deputy Halligan, agrees and is fighting very hard for it. I know how hard he has fought at Cabinet and with the Minister as well as during the talks on the programme for Government. We in the south east are not second-class citizens and will not accept that status. The War of Independence was started in Tipperary and we are proud of that. Where Tipperary leads, Ireland follows and we are entitled to health care which is as good as that available anywhere else in the country. There are 780 patients waiting at the moment. They are sick people who have been referred for this treatment. I welcome the mobile cath lab, but I do not have a lot of meas in it. It will certainly deal with the backlog, but we still need a second cath lab in Waterford. If it takes all of us to come back and put down a motion as members of Fianna Fáil or as Independents to force the Government, we should do that. It is a downright insult, without any disrespect to the Minister of State, Deputy Marcella Corcoran Kennedy, that the Minister, Deputy Simon Harris, is not here today.

David Cullinane (Waterford, Sinn Fein)
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Hear, hear.

Mattie McGrath (Tipperary, Independent)
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That is especially so with the difficulties the Minister of State, Deputy Halligan, has had, which are known in the public domain, and the pressure he has been put under at Cabinet.

I thank the Minister for Transport, Tourism and Sport, Deputy Shane Ross, for being here to support his colleague in the Independent Alliance. The Minister for Health's honeymoon is well over now. He got an extra bit of time because he is young and energetic. I wished him well, but he has been a slow learner as far as health goes and has been captured by the officials in the HSE. He is a puppet for them now. I do not mind him slipping down quietly to see a hospital, which is what he should do. I want him to do it in Clonmel also. However, it is time for him to step up to the plate or get off the field. He must look after the people of the south east as well as the rest of the country. Just because they have it here in Dublin or elsewhere, that does not mean the rest of Ireland is provided for. Dublin is not Ireland and the HSE must be held accountable. The former Ceann Comhairle spoke today about the massive budget overruns and the absence of accountability. We are elected and accountable, as we should be. The Minister must be accountable rather than to send a Minister of State with a script to read to us. It is an insult and a disgrace and we will raise the matter here again on the Order of Business and everywhere else.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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I thank the Deputies for affording me the opportunity to speak to this very important issue for their constituencies this afternoon. The Minister, Deputy Simon Harris, has asked me to convey his sincere apologies to the Deputies present. Unfortunately, he has another engagement which he was unable to avoid.

Mattie McGrath (Tipperary, Independent)
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It must be very important.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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It is.

Mattie McGrath (Tipperary, Independent)
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So is the south east.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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Indeed, and I hope I will be able to emphasise how important and how seriously the Government, including the Minister, Deputy Harris, and the HSE are taking this issue.

The House will be aware that last year, in line with a commitment in the programme for a partnership Government, an independent review of the need for a second cath lab at University Hospital Waterford was undertaken by Dr. Neil Herity. The review concluded very firmly that the needs of the effective catchment population could be accommodated from a single cath lab. However, investment was recommended to enhance cardiac services at the hospital and to provide an additional eight hours of cath lab activity per week to address waiting times and provide improved access for patients. At the time of the publication of the report, the Minister committed to providing the additional resources to University Hospital Waterford as recommended. I am pleased to confirm, therefore, that implementation of the recommendations of the Herity report has been identified as a priority action in the HSE national service plan 2017. To this end, an additional €500,000 has been allocated to the hospital for the coming year. The Minister has also committed to a further review after these extra investments have been put in place.

Following his visit to the hospital last November, the Minister asked the HSE and the south-south west hospital group to address the waiting lists for cardiology procedures at the hospital as a priority. I am delighted to report that very significant progress has been made in recent weeks. Indeed, waiting list data compiled and published by the National Treatment Purchase Fund last week shows that the cardiology inpatient and day-case procedure waiting list at the hospital has been reduced by almost 20% since the end of November while the number of persons waiting longer than a year has been reduced by some 67%.

While the Minster acknowledged warmly the collective efforts of all concerned to tackle the issue, he believes it is very important that this focus on the cardiology waiting list continues in 2017. To this end, he has been assured by the HSE that the hospital group has a robust plan in place to address the remaining backlog which involves access to cath lab capacity across the region. I am advised by the HSE that patients currently waiting over 12 months will have their procedures completed in the first eight weeks of 2017 and that patients waiting three to 12 months will have their procedures completed by June 2017. I know the Deputies will welcome that news. The House will be aware that budget 2017 made specific provision for those patients waiting longest for treatment within the health service. In this context, the Minister is considering a national cardiology waiting list initiative to address cardiology waiting lists across the country. A range of measures are envisaged including sharing of facilities and resources among public hospitals, the use of private facilities and the deployment of a mobile cath lab, including in Waterford, to augment the current plan which has been drawn up by the south-south west hospital group to address the waiting list backlog.

Further details of this proposed initiative will be made available in the coming weeks. I do not doubt that Deputies will be glad to know that as soon as those details are available they will be made aware of them.

Mary Butler (Waterford, Fianna Fail)
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I have not been in the Chamber for a long time as I was elected at the end of February 2016. However, even I know that a Private Members' motion will not change the mind of the Minister. It will certainly raise awareness, which is what I am doing today, along with other Deputies. It may influence the Government. I brought a Private Members' motion through the House in regard to dementia care and raising awareness, which did not change anything. Only 69 people out of 500 received home care packages. I know exactly what a Private Members' motion will and will not do.

John Halligan (Waterford, Independent)
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A vote of confidence could take place.

Mary Butler (Waterford, Fianna Fail)
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I ask the Minister of State not to interrupt me. I thank the Minister of State, Deputy Corcoran Kennedy, for her answer. My petition today does not concern waiting lists, to which the reply referred. Rather, it refers to 24-7 cardiology cover and the implementation of the Higgins report which clearly states, on page 87, that Waterford Regional Hospital will continue to provide cardiology coverage for the south east population working in collaboration with cardiology services in Cork and that the current service should be extended with new appointments of cardiologists.

I have the book from which I have taken that information, which was published in 2012. We have taken note of the Herity report but not the Higgins report. The people in Waterford and the south east will continue to wait for 24-7 cardiology cover.

David Cullinane (Waterford, Sinn Fein)
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I do not for one moment doubt the sincerity of the Minister of State, Deputy Halligan, on this issue but I do doubt the commitment from the Government to deliver for the people of the south east. It is not good enough that we are again being subjected to second best, second class services, with patients having to travel. When one strips everything away and takes all of us in the Chamber out of the equation, this is about 500,000 people who live in the south east. They want to be treated the same as everybody else. The reality is that across the south east we do not have access to emergency out-of-hours cardiac services, and that will continue unless the Government changes its mind.

The mobile labaratory is welcome, in so far as it will reduce waiting times. However, it should not be presented as some sort of solution to the problem. The consultants in Waterford and elsewhere in the region are not living in a post-Herity world and do not accept the Herity report. They are as resolute today as they were before the report was published. They argue that the terms of reference were flawed and the outcome was not good for the patients of the south east. They, along with all of us, want 24-7 emergency cardiac care for the people of the south east.

Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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I accept what the Minister of State, Deputy Corcoran Kennedy, said. She has good intentions, but her reply was not good enough. We can all play politics with hospitals if we want to and talk about what we did and did not do over the past 20 years, but we are where we are today.

I travelled throughout south Kilkenny during a by-election and a general election during the past two years. Every house I went into in south Kilkenny referred to cardiac services. People asked me what would happen if they, their husband, son, daughter, father or mother had a heart attack because from 5 p.m. on Fridays until 9 a.m. on Mondays services are only available in Cork.

People living in south Kilkenny, south Wexford, South Tipperary or Waterford have to be brought to Cork for treatment. We all know that those who have had heart attacks need to reach services in time - we do not need to be doctors or professional people to know that.

Deputy Butler mentioned the Higgins report. The Herity report is a stitch-up because it overruled the Higgins report. The Higgins report made it plain that a second 24-7 cardiac service was needed for the people of the south-east. The Herity report counteracted that view.

John Halligan (Waterford, Independent)
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I thank Deputy Cullinane. I am sincere in what I am trying to do. I am convinced that fairness will prevail in the end and a second cath lab will be delivered. There is no question about that. Do I think that the mobile cath lab is ideal? I do not, but it is a small step forward. That is all I am saying. I am not saying it is the answer. I agree with everybody that we need and deserve a second cath lab.

Mary Butler (Waterford, Fianna Fail)
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Yet the Minister of State chose to attack me.

John Halligan (Waterford, Independent)
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Someone said this was not about politics but it is. Everybody here makes political decisions. The people on the other side of the House have the ability to put the Government and me out of office. If they are sincere-----

Mary Butler (Waterford, Fianna Fail)
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The Minister of State has threatened-----

John Halligan (Waterford, Independent)
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Let me finish. Let us be honest about this. They, rather than the Independent Alliance, hold the majority say in the Government. They could table a motion of no confidence in the Government if it does not bring forward a second cath lab. That will do it. I am not sure whether such action could be taken in a vote on a Private Members' motion on which the Government was defeated, but I am sure if a motion of no confidence in the Government came from Fianna Fáil on the necessity of a second cath lab in Waterford it would be supported by Sinn Féin and many other Independents, and that would be the end of it. The Government would have to provide a second cath lab or fall. I know that is not the solution.

Mary Butler (Waterford, Fianna Fail)
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The Minister of State is passing the buck.

John Halligan (Waterford, Independent)
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I am not passing the buck. Rather, I am making the point-----

Mary Butler (Waterford, Fianna Fail)
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He is passing the buck.

Mattie McGrath (Tipperary, Independent)
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This is a very serious issue and we should not be fighting over it. The Minister of State, Deputy Halligan, should be careful for what he wishes. Christmas has gone and the turkeys have come home to roost, but he never knows what is coming.

The Higgins and Herity reports are HSE spin. I am not castigating the people who produced the reports but what is important are the questions they asked, the lead-in they had and the feed-in they got from patients. The officials who have now captured the Minister, Deputy Harris and the Minister of State, Deputy Corcoran Kennedy are control freaks.

Some 500,000 people in the south east are not less decent and do not deserve less respect than those in Dublin 4 and the leafy suburbs. We are their representatives and messenger boys, and are here to carry the message that we are entitled to a second cath lab.

We welcome the mobile unit. Perhaps we should take the wheels off it and see whether we can keep it in Waterford before it is moved Dublin or elsewhere because of shortages. I do not accept the reply of the Minister of State, Deputy Corcoran Kennedy. The Minister, Deputy Harris, should be here because this is his place. He is probably sitting in his office with officials watching the debate and will say I was very hard on him. I will be hard on him. He has had his honeymoon. He is accountable to the people of the south east and he must sit up and listen.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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I wish to assure the Deputies present that the Minister, Deputy Harris, is not sitting in his office watching the debate. I will convey all of the points they have made to him. I wish to provide some reassurance on concerns around whether the area is being neglected.

At the end of December 2016, there were 4,623 patients on cardiology inpatient day case waiting lists nationally, of which 489 were in University Hospital Waterford. That shows that while there are challenges, University Hospital Waterford is not being singled out in any way. There has been an improvement, in that 14 patients within the cohort of the 489 have been waiting for more than 15 months compared to the November figure when 113 patients had been waiting for more than 15 months. The improvements are incremental, but they are still improvements and it is important that we acknowledge that.

We must also acknowledge the commitment of the people in the hospital to deliver on this. The figures provide evidence that 97% of patients are receiving an appointment for an inpatient day case procedure within 15 months, which is above the 2016 target of 95,000. I know there are concerns and that people are unhappy, but I wish to reassure everybody that every effort is being made bring down the figures. I also want to reassure people that the Government, the Minister, Deputy Harris and the HSE are absolutely committed to fulfil this.

On the 24-7 PCI services, the Minister for Health has made it clear that before there are any changes in how services are delivered he wants to establish how services are improved for the patients using them. The implications of ceasing the primary PCI services will be addressed by undertaking a national review of all primary PCI services, with the aim of ensuring that as many patients as possible of access to 24-7 PCI services. The review will be completed by the end of July 2017. I hope Deputies will accept our assurances that every effort is being made to provide services that people deserve.